Weight-loss drugs have become part of popular conversation among doctors and celebrities, for reasons ranging from tackling serious obesity to gaining aesthetic benefits.

As makers of the injectable weight-loss drugs Ozempic/ Wegovy (or semaglutide from Novo Nordisk) and Mounjaro (tirzepatide from Eli Lilly) expand their markets and look at India as well, Scottish-Swiss writer and journalist, Johann Hari points to Japan’s experience and learnings for India and other countries, navigating their way through diets and weight-loss drugs. (India has the oral pill version of semaglutide.)

“Japan is the only country in the world that got rich without getting fat,” Hari writes in his book, “Magic Pill -the extraordinary benefits and disturbing risks of the new weight-loss drugs”, where he researches the popularity of weight-loss drugs, despite concerns linked to them.

Obesity has “exploded” around the world and it’s not because people are lazy or weak-willed, Hari told businessline, speaking from London. People become obese when they move from “mostly eating fresh whole foods to mostly eating factory assembled foods that are constructed out of chemicals in a process that isn’t even called cooking. It’s called manufacturing food.,” says Hari.

Japan’s schools have no overweight children, he says, pointing to their “conscious government design”, years ago. “Processed food is strongly discouraged … and (India) can take that path as well”, he says, to avoid the situation Britain and the United States now face, where people have to make a difficult choice “of continuing to be obese or taking these potentially risky drugs.”

“Unknown unknowns”

Hari writes, “With these weightloss drugs, there are known unknowns, relating to thyroid cancer, loss of muscle mass and malnutrition, where we aren’t sure yet of their scale. But, there are also unknown unknowns.”

Novo Nordisk told the author, they monitor patient safety profile and pointed to the product’s use in diabetes for 15 years and weight-loss for about eight years. On thyroid cancer risk, it pointed to the European regulatory authority finding no evidence of links to the drug. Nevertheless, the author points to the safety leaflet of the drug in the US advising against use in patients with a history of thyroid cancer. Eli Lilly did not respond to the author’s queries.

People taking the product put on weight, once they stop, making it a life-long requirement. Hari cautions on exposing children to these products. “We don’t currently know the risk to adults of taking these drugs to treat obesity for ten or twenty years – so we have absolutely no idea about the risk of what will happen to children who will be potentially taking it for eighty years,” he writes.

Hip-replacements & wedding rings

Financial analysts expect the pill to impact businesses including - fast-food makers, aviation companies, hip and knee device makers and even wedding-ring makers – anticipating a less-obese population, the book says. Having taken the injectable, Hari advices those with BMI between 27 and 35 (like himself), to look at the risk of obesity versus that of the drug and “really weigh those risks for yourself.”